Wednesday, May 17, 2006

Vacation Posting

Should be banned by the health care authorities of this country. The next two posts were written by me while on vacation and while my mother was impatiently tapping her shoe to get me going. Which is a long way of saying that I had not read the original report but only the Washington Post article take on it when I wrote those posts.

And I have to eat some of my words because the report is not that bad. It stresses the health of the women as well and not just the potential health of their future potential fetuses, and it also emphasizes the importance of planning pregnancies. But the quote from the Washington Post article which initially made me so angry, this one:

New federal guidelines ask all females capable of conceiving a baby to treat themselves -- and to be treated by the health care system -- as pre-pregnant, regardless of whether they plan to get pregnant anytime soon.

Among other things, this means all women between first menstrual period and menopause should take folic acid supplements, refrain from smoking, maintain a healthy weight and keep chronic conditions such as asthma and diabetes under control.

While most of these recommendations are well known to women who are pregnant or seeking to get pregnant, experts say it's important that women follow this advice throughout their reproductive lives, because about half of pregnancies are unplanned and so much damage can be done to a fetus between conception and the time the pregnancy is confirmed.

is still a fair summary of what the report says.

A little background for my anger. In the early 1990s a very similar report appeared and the language of that recommendation was almost exactly like the above quote. This meant that I assumed the current report to match the tone of the earlier one. It doesn't, not quite, but it isn't complete light and loveliness, either.

As I already noted the report does address the health of the fertile women themselves but the term "preconception care" is a most unfortunate one, especially for those women who are in their late forties and looking towards menopause rather than any more pregnancies, and while almost all the detailed proposals in the report are about situations where women may quite reasonably become pregnant the overall argument is that preconception care should apply to all women in their fertile years, including those who never plan to be pregnant, those who are not partnered and those who have finished their childbearing. Or rather, the existence of such groups of women among the fertile age group is mostly ignored in the report. It also ignores preconception planning for men but perhaps that is something that will appear in a separate recommendation around Father's Day.

And I'm still unhappy with the idea that all fertile women should live as if they might become pregnant tomorrow, even if they have no plans to have children any time soon. Consider alcohol. Drinking some red wine can be good for your heart but bad for an embryo. Should all women abstain from alcohol consumption, even at some risk to their own health? Or take a more serious question: What happens when a medical treatment a fertile-age woman needs might also harm a potential fetus? Is the recommendation that the woman should suffer without the treatment, even if she has no plans of becoming pregnant? These are not idle questions.

Most "preconception care" health advice contributes to the health of both the woman and any future baby she might have. But what happens when this is not the case? How seriously are we to interpret the idea of pre-pregnancy, in other words?

Then put all this into the context of the recent assaults on abortion rights and the likely future contraception wars, already brewing in the pro-life groups. It's hard not to feel that potentially always pregnant is the only possible state for most women in the dystopian future, and seeing this viewpoint in a medical report, well, it does things to my emotional buttons.

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